Category Archives: Trust

New Year, New Decisions

Studying Choices and Making Choices
I love studying decision making.  But it tends to inhibit my own ability to choose — as if making my own decisions should be perfect, knowing what I do about all the ways to make mistakes.  This year, has tested my willingness to trust my own decision-making processes.  It was high time for me to put my own “skin in the game” and live according to some consequential choices.  Unlike the “experts” on TV, who rarely review their prior predictions, yet blithely offer more  for the coming year, I prefer to start each new year by rethinking the prior one.
Since I am a decision scientist at heart, I don’t make resolutions at the start of a New Year.  Instead, I choose 1 or 2 goals to embrace and 1 or 2 bad habits to drop.  Last year, I had two positive goals — to be better about priority setting and to smile more.  Similarly, I had two negatives to eliminate —  to avoid having frustration with people boil over into anger and to waste less time watching  sports, especially the NFL.  Both major commitments, to set priorities and avoid anger — contributed to the major decision to uproot my family and take a new job across the country. My increasing frustration with work led to less anger and more reflection on why I was angry. This led to a recognition that I needed to change my work situation. Not necessarily to leave my position at the University of Chicago, but to make clearer my priorities to people — honestly and not angrily.
Choices from 2017
This has been an amazing and surprising year, and this last day of 2017 is no exception, as I have another hour to wait for midnight to arrive. Despite a nearly lifelong desire to live in Southern California — ever since being a 16 yo lifeguard listening to the Beach Boys in rural Illinois — I had assumed I would never leave the Midwest. Yet, here I am, still waiting almost two more hours to ring in the new year, after a spending the day in 70 degree weather Pasadena, California!
This led to exploration of my options, including the one here at City of Hope. With the support of my wife Tamra, and the willingness of my boys Xander, Harrison and Austin, I decided it was time for a major change. They’ve all been fantastically supportive, even when we lived apart for the first 3 months of the transition.
It was a great decision for me — no regrets. Yes, I do still miss many of my Chicago colleagues, but not the weather. My new home office, a stand-alone structure on our new property, with a beautiful view out to the San Gabriel Mountains, is something I thought I’d get when I retired. The commute is easier, and I’ve learned so much new about a lovely part of our country. The boys have adjusted heroically to their new school situation, especially Xander, who has embraced high school and the challenges of adolescence with a maturity I didn’t know he had.  Seeing him do this reminded me of the difficulties I had moving a much shorter distance as a similar time in my life.  It is delightful seeing him handle it much better than I did.
Choices for 2018 
It’s time for setting some goals for this year, a positive one, for a new capacity to realize, and a negative one, to drop (or at least minimize), to create room for growth.  My positive one is to wright creatively more often, to express myself through words more freely, honestly, and boldly.  The people I admire most, with the possible exception of my patients suffering with advanced cancer nearing the end of their lives, are writers.  It is why I treasure my library and buy old books — to remind me of the treasures of the past. But it intimidates me to try to do this myself. But as I close in on 50, it is high time for me to embrace my own muse.  My negative goal is to reach out more to others, to be less passive about my relationships.  Rather than wait for others to connect, to seek connections myself.  Both of these are rooted in my commitment to make better choices, to live that which I so often study.
William Dale
Dec 31, 2017

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Filed under Books, Chicago, City of Hope, Decision Making, Risk, Trust

Paying It Forward


Earlier this week, I lost my University ID card (actually, two of them, for the University and the Hospital, clipped together) , which basically contains all my access on-campus. Pondering the pain of replacing them, I received a message via FB Messenger from someone I’d never met who’d found it in a parking lot. We arranged, via FB, for my wife to meet this angelic person at her work, and I got my ID back in less than 24 hours. And oh, by the way, Tamra Dale walked a mile through freezing temperatures to retrieve the ID for me.

So, feeling extra lucky, I go to my eye appointment. And I find someone’s open billfold at  the local establishment, clearly unintentionally left behind. I pick it up and give it to the ladies working at the optometry office, they identify the owner and call her, she comes to the office to get it.  As I happily sit anonymously enjoying her delight, the ladies say, “Don’t thank us — thank the doctor here who found it.” And she delightedly turns to me and says, “Thank you, doctor.”

Just a shout out to a momentarily orderly world, with kind and thoughtful people, using technology invented by other smart people, and working voluntarily together to make life a little better for each other, for no other reason than a shared sense of humanity.

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Filed under Chicago, Philosophy, Trust

Trust and Behavior – Personal, Professional, and Political


My wife and I are placing significant trust in two young people we’ve never met before tonight.  We’re going to dinner together and leaving our boys — ages 11, 8, and 8 — with two strangers we’ve only met on the phone.  We’re even doing so in a place we’ve never been before.  Hopefully, we won’t be arrested for parental negligence, like a Florida mom was for allowing her 7 year old to walk to the park.

In addition to the trust we’re placing in these two young women strangers, we’re placing a significant amount of trust in our young boys, especially our eldest son.  He’s a smart 11 year old kid, with reasonable judgment, generally cautious, but with bouts of immaturity. We’ve gone through contingencies, he has a phone to contact us, and he wants to be more “grown up”.  He’s done well given appropriate leeway in the past.  Unfortunately, as Nicholas Nassim Taleb and others point out, successful past performance isn’t always a reliable guide to future success – a problem when large consequences are at stake. Our 8 year-old twins are rambunctious boys, one is very risk-averse and the other is risk-seeking; both are argumentative.  All of this was relayed to the babysitters.  They seemed perplexed that we were telling them all of this – apparently recognizing the extreme risk-aversion in the parents as more important than that of the kids.

The paradox of trust is that it involves a judgment of people in the face of insufficient evidence and lots of uncertainty.  Human beings make choices, and past action in similar circumstances is no guarantee of similar future action.  Even more difficult is predicting how people will behave in brand new circumstances. Trust when applied to human beings requires a judgement about character – that their virtues/values will guide their actions in a consistent, life-affirming way.  But there is no guarantee.  And mistakes are brutal in their consequences.  And yet, the greatest rewards flow to those who take the biggest risks.  As someone who studies decision making in a medical context, I’m hyper-aware of all of these issues.


I spend much of my professional life as a physician counseling people on risk.  As a physician caring for older patients with cancer, I’m constantly trying to provide my best advice for patient to balance the risks of having cancer with the risks of being treated for cancer.  One of my personal practice patterns is not only to tell patients and families what I think they should do, but to explain at some length WHY I suggest this.  Most appreciate knowing this additional information, although some find it overwhelming and confusing.

Over time, many of my patients have come to trust my judgment, even to the point of insisting that other doctors contact me before they allow a procedure or a treatment to take place.  I believe this trust comes from three sources: my willingness to explain the uncertain trade-offs they face, my constant reassurance that their quality of life is my highest goal, and my willingness to support whatever decision they ultimately make.  Also, my track-record is pretty good, in telling people what to expect, which tends to inspire trust.  The investment of extra time in clinic is worth the improved outcomes down the road.


I often marvel at the willingness of politicians to make definitive statements about uncertain events involving many people.  Having to act on issues that affect millions, or even billions, of people in the face of such uncertainty would be virtually impossible for most people, and certainly for me.  Yet we ask our presidents to do this on a nearly daily basis.  Today, I read in the news that we’ve decided to use military force, in the face of rising violence by terrorists, in the form of bombs, in Iraq.  Having supported our on-going troop withdrawl from that country, I’m unsure this is a good idea or not.  Hopefully, it will help the beleaguered people in the north of the country being brutally killed by the terrorists.  On the other hand, it might lead to escalation of violence in the country, increasing the overall violence in the area, to little effect.  Even worse, it appears to be a concession that our current policies in Iraq specifically, and the Middle East general, are failing.  I’m not sure whether this is a good thing to do, and I do not trust our government to choose wisely.  In the face of all this uncertainty, I truly don’t understand how to feel any trust.  As Ronald Reagan reminded us, when it comes to the politics of foreign policy, “Trust, but verify.”


Throughout the night, several people asked us, “What did you do with the kids? You didn’t leave them alone, did you?”  We received several text messages from the kids, including pictures of them having fun at the amusement park.  We had a fun, relaxing time, even seeing a celebrity from a favorite TV show, proving that Black Swan events aren’t always negative events.  We returned home from our event to find that the kids had a great time — and to our surprise, so did the sitters!   The kids spent many hours playing on the beach and riding rides, playing games, and eating ice cream.  The sitters had many delighted stories to tell. A win all around – we were right to trust the young ladies.  Professionally, my clinic continues to grow, enough that I need more time and space to see everyone we need to see.  Referrals continue to pour in.   Politically, unfortunately, I see no end to the problems, which continue to grow as we  drop some more bombs on Iraq.


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Filed under Decision Making, Philosophy, Risk, Trust